Vaccine for conflicted reasons

More high-risk cases of human papilloma virus (HPV) — that causes cervical cancer — can be detected by offering home-testing kits to women who do not come forward for cervical screening, reported the British Medical Journal Online on Friday. Sanchita Sharma tells more...

More high-risk cases of human papilloma virus (HPV) — that causes cervical cancer — can be detected by offering home-testing kits to women who do not come forward for cervical screening, reported the British Medical Journal Online on Friday. While screening and vaccination in developed countries have reduced cases of death from cervical cancer, it continues to be the number one cancer among women in India with 1.32 lakh new cases every year. Of the 2.7 lakh cervical cancer deaths each around the world in 2008, 74,118 occurred in India.

India accounts for more than one-fourth of the deaths worldwide because 80 per cent of the cases are diagnosed in the last stage. Early detection is a cost-effective way of protecting women, elaborates a large international study in The New England Journal of Medicine last year.

PATH, in collaboration with the Indian Council of Medical Research and the state governments of Andhra and Gujarat, is vaccinating an entire 10-to-14 year-old girl population in the Khamman district of Andhra Pradesh and the Vadodara district of Gujarat. This is to determine vaccination delivery through the public health system to the masses in urban, rural and tribal areas. The project is already drawing flak from women’s activist groups who say the vaccine’s effectiveness is not adequately proven.

“The HPV vaccines have been approved for use in India by the Drug Controller General of India. They are safe and being prescribed for use in the private sector,” said Martha Jacob, director, reproductive health and infectious diseases, PATH India.

Women’s activists groups argue that the vaccines do not guarantee protection against cervical cancer. From over 100 HPV subtypes, Gardasil (Merck) protects against HPV 6, 11, 16 and 18 and Cervarix (GSK) against HPV 11 and 16.

HPV types 16 and 18 cause 70 per cent of cervical cancers, and HPV 6 and 11 cause 90 per cent of the highly contagious sexually transmitted anogenital warts, says the World Health Organization. According to the Indian Journal of Sexually-Transmitted Diseases, over 50 per cent of sexually active (15-25 years of age) have been infected with one or more HPV types.

“What is the logic of vaccinating young girls against an illness that very few of them may acquire 30 years later, largely due to persistent presence of four out of over 100 HPV subtypes,” said N. B. Sarojini of Sama Resource Group for Women and Health.

“Though the vaccine is available over the counter, there are several unresolved issues about its effectiveness, so if you ask me whether it should be made part of the government programme based on available data, I would say no,” said Dr G. K. Rath, chief of the Institute Rotary Cancer Hospital at the All India Institute of Medical Sciences.